Blosana (BLONANSERIN)

brands

Class

• Atypical antipsychotic (serotonin– dopamine antagonist; second-generation antipsychotic; also a potential mood stabilizer)

Blosana commonly prescribed for

(Bold for FDA approved)

How Blosana works

• Blocks dopamine 2 receptors, reducing positive symptoms of psychosis and stabilizing affective symptoms

• Blocks serotonin 2A receptors, causing enhancement of dopamine release in certain brain regions and thus reducing motor side effects and possibly improving cognition and affective symptoms

• Actions at dopamine 3 receptors could theoretically contribute to blonanserin’s efficacy

How long until Blosana works

• Psychotic symptoms can improve within 1 week, but it may take several weeks for full effect on behavior as well as on cognition

• Classically recommended to wait at least 4–6 weeks to determine efficacy of drug, but in practice some patients may require up to 16–20 weeks to show a good response, especially on negative or cognitive symptoms

Notable Side Effects

• Akathisia, drug-induced parkinsonism

• Insomnia, anxiety, sedation

• Urinary retention

• Tardive dyskinesia (reduced risk compared to conventional antipsychotics)

• Risk of potentially irreversible involuntary dyskinetic movements may increase with cumulative dose and treatment duration

Life Threatening Side Effects

• Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients taking atypical antipsychotics

• As a class, antipsychotics are associated with an increased risk of death and cerebrovascular events in elderly patients with dementia; not approved for treatment of dementia-related psychosis

• Rare neuroleptic malignant syndrome may cause hyperpyrexia, muscle rigidity, delirium, and autonomic instability with elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure

• Rare seizures

weight gain

unusual

sedation

common

What to do about Blosana side effects

• Wait

• Wait

• Wait

• Anticholinergics may reduce drug-induced parkinsonism when present

• Beta blockers, benzodiazepines, or serotonin 2A antagonists (e.g., mirtazapine, cyproheptadine) may reduce akathisia

• Weight loss, exercise programs, and medical management for high BMIs, diabetes, dyslipidemia

• Metformin may help prevent or reverse antipsychotic-induced weight gain

• Switch to another atypical antipsychotic

usual dosage range

• 8–16 mg/day divided in 2 doses

Dosage Forms

• Tablet 2 mg, 4 mg, 8 mg

• Powder 20 mg per 1 g powder

long term use

• Not extensively studied past 56 weeks, but long-term maintenance treatment is often necessary for schizophrenia

• Should periodically reevaluate long-term usefulness in individual patients, but treatment may need to continue for many years

habit forming

• No

Renal Impairment

• Not studied

Hepatic Impairment

• Use with caution; may need to lower dose

Cardiac Impairment

• Use in patients with cardiac impairment has not been studied, so use with caution

Elderly

• Some patients may tolerate lower doses better

• Although atypical antipsychotics are commonly used for behavioral disturbances in dementia, no agent has been approved for treatment of elderly patients with behavioral symptoms of dementia such as agitation

• Elderly patients with dementia-related psychosis treated with atypical antipsychotics are at an increased risk of death compared to placebo and also have an increased risk of cerebrovascular events

Children and Adolescents

• Safety and efficacy have not been established

• Children and adolescents using blonanserin may need to be monitored more often than adults and may tolerate lower doses better

Pregnancy

• Controlled studies have not been conducted in pregnant women

• Psychotic symptoms may worsen during pregnancy, and some form of treatment may be necessary

Breast Feeding

• Unknown if blonanserin is secreted in human breast milk, but all psychotropics are assumed to be secreted in breast milk

• Recommended either to discontinue drug or bottle feed unless the potential benefit to the mother justifies the potential risk to the child

• Infants of women who choose to breast feed while on blonanserin should be monitored for possible adverse effects